Living (and Dying) Te Whare Tapa Whā

Our Aukaha – Rangahau Dr Hirini Kaa recently went through a serious health issue and ended up in hospital for two months. Here he shares some reflections on his experiences and what he might have learned from them.

Ta Mason Durie has given us many gifts over the course of his amazing career. His thinking has been a key part of ‘Te tino waere ataahua’ the New Way for us as Māori. Others would include Ranginui Walker, Tā Hirini Moko Mead, Linda Tuhiwai Smith and Ngahuia Te Awekotuku. Leading us to a new intellectual future where our mātauranga can thrive and be openly acknowledged for its inherent value.

Among his most well-known contributions must be Te Whare Tapa Whā. In some ways it is a deceptively simple model for health and wellbeing. It simply says that rather than merely the physical element to medicine as the Western world focuses on, we approach this more holistically, incorporating: Taha Hinengaro, Taha Whānau, Taha Tīnana, Taha Wairua.

While some take this model as definitive, I have heard Tā Mason talk about it as a beginning. Its brilliance as a model is that it cuts through the Western approaches in such a clear way, by presenting a compelling vision of what is required for Māori healing and wellness. It doesn’t necessarily critique Western modes – which have failed us greatly over time – instead it points to our strengths. Tā Mason’s rangahau on our strengths has been such a gift to us all.

And I’ve been able to use this model in a number of settings. I was on the Royal Australasian College of Physicians Ethics Committee for a number of years and they would talk about “patient centred care” which they saw as a great improvement over the clinician as the centre. While I agree this was an improvement, I could refer them to the importance of whānau in the healing process.

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A couple of months ago I had an operation on my heart. From birth my heart had a hole between two chambers. When I was in my early twenties this became a problem, so they conducted open-heart bypass surgery to fix it. Not only did it not work, but I still have an impressive scar – I’m a member of the zipper club.

Several months ago, the cardiologists in their wisdom decided to try again. This time it would be by keyhole surgery. And it worked brilliantly. I was up and about the next day, going home feeling great. And felt great until the following week, when things went wrong.

It turns out during the keyhole that another artery collapsed, and a giant haematoma appeared at the keyhole site. “Not to worry” they told my whānau as they wheeled me off for a quick op to fix it.

Unfortunately, from then on, everything that could go wrong, did go wrong. My newly tinkered-with heart didn’t like the extra attention and shut down. My renal system also wanted some attention and shut down as well. I think my body might be unionised. The doctors in ICU Cardiac at Auckland City Hospital worked the hardest they could but told my whānau “it could go either way”.

In some ways, I think it did go both ways. I had vivid and intense dreams in the week I was in a coma. Some of this was down to infection fevers and the fentanyl they gave me. I had dreams of everything from being a cosmonaut against my will through to Donald Trump personally focusing his wrath on me.

But in there was something deeper. I have been taught that death is not merely the end of life, but the whole transition. As we near the end of life our tīpuna gather, and the full power of creation is near. That’s what makes death so tapu. If life does end, then we are still in that state until we are sent on our journey to Hawaiki/Heaven – whatever you choose to call it. I feel that I was crossing back and forward, or certainly near that state.

One part of this was in dreams. I had a dream that I was in a waka where they had cut a channel into the middle of a wharenui so we could row straight in. It was an unusual wharenui made of stone. Meantime in “real life” my elder brother was there with me for much of this time, sleeping in the waiting room and a constant presence. He went home for a couple of nights and he had dreams. The first night he was walking along a road. The second night he dreamed he came across a wharenui made of stone and shaped like an igloo. When he opened the doors, it was full of water. Then I had another dream where I was on the road outside the whare and my brother was there doing a whaikōrero. He had come to bring me back.

As a whānau we take these things in our stride. Our Nan in particular, showed us that these things are natural, not to be afraid of. She was our connection to Te Ao Tāwhito and the many gifts of our tīpuna. And the primary place of wairua in our lives.

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Spoiler alert: I recovered. Recovery was long and slow. It took weeks for my strength to recover, when even lifting my hands was a struggle.

The kaimahi in the hospital were amazing. The nurses worked so well together, and nothing was too much for them. The amazing doctors tried their best to be human, and through it all I could see the influence of Te Whare Tapa Whā. My mental health suffered in ICU, which is not uncommon. This was recognised and addressed. Of course, my tinana was the primary focus, and they did brilliant work to save and restore me in that dimension.

There was also a huge focus on whānau. All the kaimahi constantly brought whānau into the kōrero in a real way. They would ask after them and ask me when whānau would be visiting. The best moment was with Mohamed, a wonderful physio from South Africa. He said in South Africa the only visiting hours in hospital were 8-9 pm. Whereas he said he could see here the deep value of whānau in the healing and restoration of people.

And of course, the wider dimensions of rangahau/research were on full display. From the amazing keyhole surgery through to the modern drugs, the seemingly miraculous developments in medicine were on full display, for which I am deeply grateful.

I’m not naive. I know inequity pervades our health system. I know our Rongoā could be better integrated, as it is in China, for example. But I am thankful for rangahau. And those who led the way including Tā Mason have enabled a new generation of Kairangahau, including Elena Curtis, Papaarangi Reid and George Laking. They will ensure other lives are saved and restored, and that the value of our mātauranga will be recognised for what it is – lifegiving.

Further Reading:

Te Whare Tapa Whā (Ministry of Health) Te Whare Tapa Whā model of Māori health | Ministry of Health NZ